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Clinical picture and methods of treatment of hemorrhagic pancreatic necrosis, the danger of the disease. How dangerous is acute hemorrhagic pancreatic necrosis?

Hemorrhagic pancreatic necrosis– a disease of the pancreas, in which there is a fairly rapid death of organ cells without the possibility of their renewal. Most often, the disease manifests itself when a person has acute pancreatitis or during an exacerbation of the chronic form of this disease. Acute hemorrhagic pancreatic necrosis is diagnosed in patients from the middle and older age categories. There are no restrictions regarding gender. Pathology can develop under the influence of many unfavorable factors.

Reasons for development

Hemorrhagic pancreatic necrosis develops under the influence of the following reasons:

penetration of infectious agents into the bile ducts and biliary tract;
addiction to alcoholic beverages. This pathological condition quite often begins to develop in people who abuse alcohol and use it without any measure;
reflux of pancreatic juice back into the pancreatic ducts. Most often, this pathological condition is observed when stones form in the human gall bladder;
DIC syndrome or thrombohemorrhagic syndrome. These two pathological conditions progress in people after chemotherapy, with the development of diseases of a bacterial and viral nature;
progression of pathologies of an autoimmune nature. IN this group primarily hemorrhagic vasculitis;
organ trauma. May occur as a result of strong external influence(for example, a blow) or when performing surgical intervention on organs localized in abdominal cavity.

If a patient has progressive local or total hemorrhagic pancreatic necrosis, then the acinus will definitely be involved in the pathological process. This special department gland, which is responsible for the production of enzymes that are components of pancreatic juice. If their number becomes very large, then they begin to negatively affect pancreatic tissue and blood vessels. An enzyme such as elastase corrodes the wall of the vessel, thereby provoking the occurrence of hemorrhages (hemorrhages). Hence the name of the pathology - hemorrhagic pancreatic necrosis.

Symptoms

This disease usually occurs with a pronounced clinical picture. An acute form of pancreatic necrosis can lead a person to collapse, and a third of patients with this diagnosis have psychological disorders. The progression of the disease is accompanied by the formation of specific pancreatic-retroperitoneal fistulas - this leads to the contents of the pancreas, including dead cells, penetrating into the peritoneum. It is for this reason that patients develop abscesses of abdominal tissue and peritonitis. Even with treatment, the prognosis can be disappointing - in half of the cases the person dies. The cause of death was severe intoxication syndrome.

The main symptoms indicating the development of pathology include the following:

redness of the skin on the face;
the occurrence of acute pain in the left hypochondrium. The pain may radiate to chest, lower back and shoulder;
on the stomach one can note the formation of several spots that have a blue-purple tint;
dry mouth. If you examine the oral cavity, you will notice that the sick person’s tongue is coated;
increase in body temperature to critical levels;
nausea and vomiting. A person vomits many times, but his condition does not improve;
abdominal bloating and flatulence;
impaired excretion of feces - a person experiences severe diarrhea;
Heart rate increases;
dyspnea;
blood pressure indicators are constantly changing - a sick person may experience both hypertension and hypotension;
the volume of urine excreted decreases;
mental disorders.

If the patient has at least one of these signs, he should be immediately taken to medical institution for diagnosis and complete treatment.

Diagnostic measures

The first stage of diagnosis is interviewing and examining the patient. It is important for the doctor to clarify the first time of expression of symptoms, their intensity, and the location of the pain. In addition, it is clarified whether the patient has any chronic diseases, in particular, the pancreas. Next, the abdominal cavity is palpated and the skin and mucous membranes are examined.

The second stage is conducting laboratory and instrumental diagnostics. The most informative methods include:

blood and urine analysis;
general clinical;
a blood test to determine the level of pancreatic enzymes;
excrement analysis;
urine analysis to determine the level of uroamylase and trypsinogen;
assessment of gastric juice acidity;
retrograde cholangiopancreatography performed using endoscopic equipment;
percutaneous puncture of a site with necrosis.

In some situations, doctors may resort to abdominal laparoscopy.

Therapeutic measures

Treatment of hemorrhagic pancreatic necrosis is carried out using conservative techniques and surgical intervention. Conservative therapy includes:

taking painkillers;
use of novocaine blockade;
intravenous infusions of Trasylol and Contrical to inhibit enzyme activity;
prescribing medications to reduce the acidity of gastric juice;
taking antibacterial drugs.

If the above measures do not bring any effect, then surgical intervention is performed.

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The pancreas is described as one of the most developed and severe pathologies. Based on the name itself, which includes the word “necrosis,” one can understand the seriousness of this disease. After all, “necrosis” is translated as “dying, dying” and is explained as the destruction of cells or tissues under the influence of bacteria, that is, decomposition.

The statistics of total pancreatic necrosis are satisfactory and sad; approximately 80% of cases end in the death of patients.

During the disease, slow decomposition of the organ occurs, which occurs due to the breakdown of cells and tissues under the influence of enzymes. The rate of damage depends on the amount of proteolytic enzymes that reach the pancreas through the lymph and bloodstream.

The death of a patient can occur as a result of serious damage to an organ whose tissue and cells cannot be restored. Everyone knows that the pancreas is responsible for the production of special enzymes that help transform food. Alas, a person cannot live without this.

This disease has a whole bunch of symptoms that indicate its presence:

, strong painful sensations which the patient first feels in the left part of the abdominal cavity, and then it is localized in the lumbar region, shoulder joint;
Nausea, vomiting, which does not bring a feeling of relief;
Strong blood flow to the face, causing it to become red;
Enlargement of the abdominal cavity, which is accompanied by flatulence;
Not stable blood pressure, which either decreases or jumps;
The pulse noticeably quickens;
Decreased urine outflow through the urinary tract;
Plaque on the tongue and a feeling of dryness in the mouth;
Shortness of breath, rapid breathing.

In addition to the above symptoms, patients suffering from this disease may have other symptoms in their clinical picture. Approximately 2/5 of patients with acute pancreatic necrosis faint, experiencing the so-called “collapse” state, while the remaining patients may develop mental illness against the background of pancreatic necrosis. For example, an uncontrollable panic state may develop.

What can trigger the appearance?

The most popular causes of hemorrhagic pancreatic necrosis of the pancreas today are:

Not proper nutrition which is accompanied by the use alcoholic drinks in large quantities along with fatty foods.
The presence of acute () pancreatitis.
Indulging in unhealthy fried foods and foods containing trans fats.
Gallbladder diseases.
Congenital or surgical pathology pancreas.

There are other provocateurs for the development of the disease, among which the following reasons can be identified:

The clinical picture that the patient describes to the gastroenterologist does not allow a complete diagnosis. All the symptoms that accompany the patient are very similar to other inflammatory diseases of the gastrointestinal tract, the treatment of which, of course, differs from each other.

In order to determine the cause of your symptoms, your doctor may prescribe you a referral for an ultrasound scan, computed tomography And . As side tests, which will help the doctor cope with doubts can be: blood test, urine test, pancreatic juice test, gastric juice test, coproscopy.

Disease prognosis.

A number of preventive measures for the occurrence of this disease include: a medical examination every six months, proper nutrition, and complete elimination of bad habits.

Based on the complexity of the case, the speed of development, methods of treatment and its timeliness, it may be like favorable prognosis, so bad.

A poor prognosis appears if a person with acute pankeronecrosis was not provided with medical care. help and he developed peritonitis. Which develops as a result of the penetration of decomposed, rotten tissue into the entire abdominal cavity, as a rule, in such cases it is found in the blood increased level intoxication.

In most cases, treatment of the disease is based on medications.

Hemorrhagic pancreatic necrosis of the pancreas will develop with the predominant activation of proteolytic enzymes. The speed at which the disease develops depends on how many of these enzymes are activated.

Gradually, other organs and tissues will be involved in the inflammatory process. fascial sheaths abdomen, this will quickly lead to the formation of hemorrhagic peritoneal effusion and will contribute to the development of aseptic enzymatic peritonitis.

Acute hemorrhagic pancreatic necrosis causes severe pain girdles in the epigastric region, and within a few hours cause obvious signs of disorder of peripheral and central hemodynamics. In every fifth patient, these disorders subsequently cause pancreatogenic shock, leading the patient to an extremely serious or serious condition. The patient's skin becomes moist, cold, pale, breathing quickens, the pulse becomes thready and rapid, and hypotension occurs. In addition, about 60% of patients who experience progressive hemorrhagic pancreatic necrosis have mental disorders expressed by inappropriate behavior, lethargy or agitation and anxiety. And every third patient has severe dysfunction of the central nervous system in the form of coma or delirium.

Hemorrhagic pancreatic necrosis is characterized by an increased 6-9 times relative to the normal level of the upper limit of the range of enzymatic activity. Also about hemorrhagic form Acute pancreatic necrosis will be indicated by foci of hemorrhage and cavities with hemorrhagic exudate in the greater omentum and gastrocolic ligament.

One more distinctive feature acute form of this disease There will be clearly expressed pain and severe intoxication of the body already in the first day after the onset of disease progression. The level of intoxication in the first 24 hours is so high that it often becomes the cause fatal outcome.

Causes of hemorrhagic pancreatic necrosis

The occurrence of hemorrhagic pancreatic necrosis is characterized by the activation of certain enzymes that come from lymph nodes into the pancreas. And from there into the general bloodstream of the body. The death of most of the cells as a result of their self-digestion by the pancreas causes this disease.

The causes of hemorrhagic pancreatic necrosis are:

inflammatory processes occurring in the pancreas;
intoxication of the body as a result of the ingestion of ethanol and other toxic substances;
biliary tract infections;
thrombophlebitis or vasculitis of pancreatic vessels, including as a result of acute heart failure;
tissue damage due to direct impact of a mechanical nature;
immune conflict of the body. When immune agents cannot recognize the body's cells. They are mistaken for foreign microorganisms and, as a result, rejected;
complications after surgical operations on the abdominal organs;
significant disorders or destruction of pancreatic tissue as a result of the presence of tumors in the body;
abuse of alcoholic beverages, which directly have a destructive effect on the pancreas, activating its secretory function.

The independent occurrence of hemorrhagic pancreatic necrosis is possible only with direct mechanical damage to pancreatic tissue. In other cases, it is formed due to an acute form of pancreatitis in combination with chronic inflammation of the pancreas.

Symptoms of hemorrhagic pancreatic necrosis

Acute paroxysmal pain in the left hypochondrium.
Dry mouth, nausea and repeated vomiting.
Bloating, flatulence and diarrhea.
Chills and significant increase in body temperature. Sometimes it is so high that the patient develops a fever and, accordingly, confusion.
Noticeable redness skin face, as well as the appearance of bluish spots on the skin of the abdomen.
Sudden jumps in blood pressure. From significantly reduced to greatly increased.
Rapid heartbeat and shortness of breath at rest.
Excited state, anxiety.
Manifestations similar to those of renal failure.
In some cases, mental disorders are observed.

Symptoms of hemorrhagic necrosis of the pancreas appear sharply and develop rapidly. Most often this occurs after a short period of time as a result of eating foods prohibited for this disease. Hemorrhagic pancreatic necrosis is very severe, but two successive phases are clearly defined, namely:

first phase. As a rule, it lasts about a week, sometimes more. During this time, proteolytic enzymes begin to actively circulate in the blood, thereby exerting a toxic effect on various organs. Buy acute manifestations is not possible with appropriate therapy;
second phase. Characterized by purulent and postnecrotic complications. It usually starts with putting it on. Infection of foci of hemorrhagic necrosis of the pancreas is endogenous. The consequences of purulent intoxication of the body are clearly manifested. The heart rate increases even more, and pain intensifies. As a result of many days high temperature body, persistent hyperthermia is noted internal organs. Bleeding may also begin as a result of arrosion of the vascular walls.

Treatment of hemorrhagic pancreatic necrosis

Conservative methods are used in the treatment of this disease. Appropriate medicines different directions.

Blockers. With their help, it is possible to block enzymatic centers, significantly reducing the level of their chemical activity.

Antispasmodics. These drugs help relax the tissues and ducts of the pancreas, improving the outflow of its secretory fluid.

Antisecretolytics. These drugs reduce gastric secretion and, as a result, reduce the functional activity of the gland.

In addition, the absence of a pronounced effect when using conservative treatment is an indication for surgical intervention.

Hemorrhagic pancreatic necrosis is one of the diseases that require urgent inpatient treatment patient under 24/7 supervision medical personnel. In this regard, the use of folk remedies is inappropriate.

Hemorrhagic pacreonecrosis is the cause of death

During the first day of disease progression, some patients experience extremely severe pain, as well as unacceptable concentrations of toxic agents in the blood.

Due to the above reasons, including the inability to detoxify the patient’s body, hemorrhagic pancreatic necrosis can cause death.

Today, there are several classifications of pancreatic necrosis, among which the most popular is the classification adopted since 1992.

Pancreatic necrosis is a complication of a disease such as acute pancreatitis (inflammation of the pancreas). Mortality associated with this serious illness.

For pancreatitis, eating ginger is considered effective, which is characterized by many medicinal properties. First of all, this product.

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PANCREATITIS

TYPES OF PANCREATITIS

WHO HAPPENS?

TREATMENT

NUTRITION BASICS

CONSULT YOUR DOCTOR!

What causes hemorrhagic pancreatic necrosis?

Diseases of the pancreas are characterized by a rapid course and high risk development of complications. A particularly dangerous disease is hemorrhagic pancreatic necrosis. With this disease, a rapid, but most importantly, irreversible process of cell death is observed. Most often, a complication develops during acute pancreatitis or during a relapse. The danger is that even timely treatment does not guarantee that necrosis will not lead to death.

Causes of the disease

In most cases, the disease develops in the presence of the following provoking factors:

violation of the outflow of juice;
acute intoxication with alcohols;
constant irritation of gland tissues with bile;
dysfunction of enzyme production;
infectious process in the gallbladder;
blood clotting disorder;
autoimmune pathologies;
condition after chemotherapy or radiation;
pancreas injuries;
condition after organ surgery.

It is characteristic that with this disease the acini are always affected. As a result, the rate of enzyme release increases sharply, leading to an increase in pancreatic juice levels. It does not have time to be excreted by the ducts and begins to activate directly inside the gland, causing its disintegration. At the same time, the level of elastase increases, as a result of which the walls of blood vessels are destroyed and, as a result, bleeding occurs.

At the same time, studies have made it clear that not only these disorders lead to hemorrhagic pancreatic necrosis. The fact is that the production of enzymes that destroy gland cells and vessel walls is also influenced by other factors. Thus, substances produced by the islets of Langerhans inhibit the production of proteolytic enzymes, and secretin, which is produced by the intestinal mucosa, on the contrary, stimulates their release.

Before starting treatment for a pathology, it is important to find out what disorders resulted from it. Based on the existing reasons, a treatment plan is drawn up.

Symptoms of pathology

Hemorrhagic pancreatic necrosis develops quickly. The following symptoms are characteristic:

the pain is always sharp, radiating to the back and left side;
severe dryness of the mucous membranes;
nausea and vomiting;
flatulence;
hyperthermia;
redness of the skin and the appearance of purple spots;
a sharp decrease in urine volume;
increase in pressure.

The danger is that even timely treatment does not always produce results. Almost every fifth patient collapses. 30% of patients fall into someone or they develop mental disorder. Especially often there is rupture of gland tissue and the entry of enzymes and necrotic cells into the abdominal cavity, which causes peritonitis with purulent contents.

Diagnosis of the disease

Pathology has only acute period. Thanks to characteristic features It is not difficult to determine the cause of the deterioration. To confirm the diagnosis, ultrasound and CT are prescribed. Particularly easy to detect acute pancreatic necrosis using laboratory tests, namely:

enzyme level assessments;
urine tests for uroamylase and trypsinogen levels;
pH analysis of juice;
probing to obtain pancreatic juice and study its composition;
coprogram with fat content assessment;
triglyceride tests.

In addition to the above, if acute pancreatic necrosis is suspected, areas of necrosis are urgently punctured to obtain material for analysis.

Considering that acute process often causes death, in some cases it is recommended not to wait for the results of the study, but to perform laparoscopy to assess the extent of gland damage and exclude involvement neighboring organs.

Treatment method

Acute pancreatic necrosis is always the cause of hospitalization. Patients are sent either to the intensive care unit or directly to surgery. Treatment has the following goals:

acute pain syndrome is eliminated;
enzymatic activity stops;
spasm from the ducts is relieved;
the production of gastric juice decreases;
prevents the occurrence of secondary infection.

Due to the fact that pancreatic necrosis is the main cause of death in gastroenterology departments, therapeutic measures must begin immediately. For this, first of all, antispasmodics are administered. Novocaine blockade has an excellent effect. As a result, it is possible to relax the ducts and ensure the release of pancreatic juice.

Next it is eliminated main reason– increased production of enzymes. Accordingly, anti enzyme preparations, secretagogues, blockers histamine receptors. From the first days of inflammation, tissue necrosis develops, so treatment in mandatory should include antibacterial therapy.

Treatment continues for several hours, after which the effectiveness and need for surgery are assessed. This increases the chances of avoiding the death of the patient.

Surgical intervention can be performed immediately after treatment. The technique directly depends on the characteristics of the course of pancreatic necrosis. In the absence of infection, laparoscopy is recommended. Percutaneous drainage of the cavity would also be appropriate. If the examination reveals a cluster large quantity exudate, it is necessary to perform abdominal surgery. In addition, a procedure such as peritoneal dialysis has a positive effect on the patient’s condition. It is thanks to him that it is possible to cleanse the blood of enzymes and toxins, reducing the likelihood of the patient dying from intoxication.

If large areas of the gland are affected, organ resection is required. Extremely in rare cases carried out complete removal organ. Regardless of which technique was used, therapy with the above drugs is prescribed immediately after the operation. In the future, enzyme preparations that facilitate the functioning of the gland will be mandatory.

Prevention of pathology

The only sure way to prevent pancreatic necrosis is to give up alcohol and follow a healthy diet. Fatty foods, hot spices, smoked foods and canned food can cause a sharp release of enzymes. At the same time great value It is not a short-term intake of strong drinks, but a systematic one. Moreover, the volume can be no more than eighty grams of alcohol. This alone will be enough for pancreatitis to form after a few years of daily use.

In addition, it is important to take into account all provoking factors. First of all, this is a dysfunction of the gallbladder. The same applies peptic ulcer and housing and communal services. It is important to remember that only timely treatment of concomitant pathologies will help avoid pancreatic necrosis. It is much easier to remove gallstones and restore the function of the digestive organs than to subsequently deal with intoxication and purulent peritonitis, which in almost 100% of cases is the cause of death in pancreatic necrosis.

Following a diet will help avoid hemorrhagic pancreatic necrosis:

My sister was hospitalized six months ago with hemorrhagic pancreatitis. I thought they were going to have surgery. But she was put in intensive care unit and the drugs were dripped for ten days. Now she is on a strict diet, but she managed to avoid surgery. We can only hope that there will be no exacerbations.

Acute hemorrhagic pancreatic necrosis and pancreatitis

Hemorrhagic pancreatic necrosis is a disease that occurs against the background of pancreatic pathology, which is characterized by a rapid course and a large volume of destruction. Often this condition leads to the death of the patient. In this article we will talk about what causes this disease.

Why does the disease appear?

As a rule, hemorrhagic pancreatic necrosis is a total process. It affects all areas of the gland and proceeds with lightning speed. Therefore, it must be provoked by powerful factors.

Hemorrhagic pancreatitis can occur when food poisoning(most often these are alcohol intoxications).
The disease appears in the background chronic pancreatitis, when the tissue has already been changed, and the patient does not follow a diet and consumes large amounts of fatty, spicy, sour foods.
Acute hemorrhagic pancreatic necrosis often occurs after trauma to the gland. Enzymes come out and trigger a cascade of destructive reactions.
Sometimes doctors provoke this condition. The cause of the disease is manipulation of the pancreatic ducts (ERCP).
Hemorrhagic pancreatitis occurs due to viral and autoimmune pathologies. For example, severe course mumps or flu can cause complications on the gland. Systemic lupus erythematosus sometimes destroys pancreas vessels.
In children, acute hemorrhagic pancreatitis can occur due to genetic disorders. Cystic fibrosis and abnormalities in the structure of the gland are causes that lead to illness and sudden death.
Diseases of the liver and gallbladder play the second most important role in the development of reactive inflammation of the pancreas (vesicle stones, duct strictures, cholangitis).

Symptoms

The causes of the disease are numerous, but as practice shows, most often necrosis of the gland develops due to alcohol consumption. Patients are admitted to the hospital with an attack within 6 hours of the onset of the disease. The following symptoms are characteristic of pancreatic necrosis:

serious condition of the patient;
pale skin and sallow complexion;
low blood pressure and thready pulse;
bloating;
muscle tension in the anterior abdominal wall;
vomiting that does not bring relief;
Cyanotic spots and hemorrhages appear on the stomach, back and sides.

As a rule, such patients are immediately admitted to the intensive care unit or ward. intensive care. It is important to exclude other sources acute peritonitis, in which it is necessary to carry out emergency surgical treatment (calculous cholecystitis, ulcer with perforation).

Pancreatic shock can cause death. Indeed, during illness, several destructive factors act: pain syndrome, intoxication of the body, the development of disorders in the coagulation system. Death occurs from multiple organ failure or purulent complications. In practice, there are cases when 1 day passed from the onset of an attack to death. Therefore, this fulminant form of pancreatitis requires immediate treatment.

Therapy

The first thing the patient needs is adequate pain relief and control of shock. To do this, the patient is injected with electrolyte solutions and protein blood products (Polyglyukin, Reopoliglyukin, Hemodez, plasma and albumin). Used for pain relief narcotic analgesics(Promedol, Diazepam). In some cases they are supplemented antihistamines 1st generation, which have not only an antiallergic, but also a sedative effect.

A mandatory point of therapy is to relieve sphincter spasm. For this purpose, antispasmodics are used (Platifillin, Papaverine, Eufillin). Severe vomiting may cause electrolyte imbalance. Therefore, solutions of potassium, calcium, and magnesium are often administered to a patient in intensive care. They help normalize the functioning of the heart muscle.

To reduce the damaging effect of enzymes, drugs are administered that reduce the effect of proteases (Trasylol, Contrical). Also, the activity of the gland is inhibited by hormonal drugs (Octreocid, Sandostatin). They reduce the area of necrosis. With their prophylactic administration during manipulation of the gland, the aggression of enzymes is reduced.

With pancreatic necrosis, the process spreads beyond the organ, forming lesions in the surrounding tissues. Therefore, surgical treatment for this type of pancreatitis is a vital necessity. Extensive abdominal operations have a poor prognosis. Doctors prefer laparoscopic interventions. In this case, foci of necrosis are removed, and drainage tubes are inserted into the infiltrates.

In the case when all methods do not give the desired effect, death occurs. With this form of the disease, it can occur on the first day of the disease. With adequate treatment, but weak body defenses, patients die 1-2 weeks after the attack. The main causes of mortality are purulent-septic complications, pneumonia, multiple organ failure, and infectious-toxic shock. In surviving patients, pancreatic necrosis leads to disability.

Disease Prevention

Total necrosis of the gland is fatal. Therefore, if you have problems with pancreas, you should be extremely careful.

Follow the diet recommended by your doctor (do not eat spicy, fatty, sour, smoked, pickled foods).
Stop drinking alcohol and smoking (drugs are also prohibited).
Treat liver and gallbladder diseases in a timely manner.
Lead healthy image life.

Total hemorrhagic pancreatic necrosis of the pancreas: 80% of patient death

Hemorrhagic pancreatic necrosis of the pancreas is described as one of the most developed and severe pathologies. Based on the name itself, which includes the word “necrosis,” one can understand the seriousness of this disease. After all, “necrosis” is translated as “dying, dying” and is explained as the destruction of cells or tissues under the influence of bacteria, that is, decomposition.

The statistics of total pancreatic necrosis are satisfactory and sad; approximately 80% of cases end in the death of patients.

How to recognize the body's signals about pancreatic necrosis?

This disease has a whole bunch of symptoms that indicate its presence:

Acute, severe pain that the patient first feels in the left side of the abdominal cavity, and then it is localized in the lumbar region, shoulder joint;
Nausea, vomiting, which does not bring a feeling of relief;
Strong blood flow to the face, causing it to become red;
Enlargement of the abdominal cavity, which is accompanied by flatulence;
Unstable blood pressure, which either drops or rises;
The pulse noticeably quickens;
Decreased urine outflow through the urinary tract;
Plaque on the tongue and a feeling of dryness in the mouth;
Shortness of breath, rapid breathing.

In addition to the above symptoms, patients suffering from this disease may have other symptoms in their clinical picture. Approximately 2/5 of patients with acute pancreatic necrosis faint, experiencing the so-called “collapse” state, while the remaining patients may experience the development of mental illness against the background of pancreatic necrosis. For example, an uncontrollable panic state may develop.

What can trigger the appearance?

The most popular causes of hemorrhagic pancreatic necrosis of the pancreas today are:

Poor nutrition, which is accompanied by the consumption of alcoholic beverages in large quantities along with fatty foods.
The presence of acute (chronic) pancreatitis.
Indulging in unhealthy fried foods and foods containing trans fats.
Gallbladder diseases.
Congenital or surgical pathology of the pancreas.

There are other provocateurs for the development of the disease, among which the following reasons can be identified:

In order to determine the cause of your symptoms, your doctor may prescribe you a referral for an ultrasound, computed tomography and MRI. Side tests that will help the doctor cope with doubts may include: blood test, urine test, pancreatic juice test, gastric juice test, coproscopy.

Disease prognosis.

A number of preventive measures for the occurrence of this disease include: a medical examination every six months, proper nutrition, and complete elimination of bad habits.

Based on the complexity of the case, the speed of development, methods of treatment and its timeliness, the prognosis can be either favorable or poor.

A poor prognosis appears if a person with acute pankeronecrosis was not provided with medical care. help and he developed peritonitis. Which develops as a result of the penetration of decomposed, rotted tissue into the entire abdominal cavity; as a rule, in such cases an increased level of intoxication is detected in the blood.

In most cases, treatment of the disease is based on medications.

Hemorrhagic pancreatic necrosis

Hemorrhagic pancreatic necrosis is a severe pathology in which rapid death of groups of cells in the tissues of the pancreas is observed. This process is irreversible and inevitably leads to disruption of enzyme and humoral function, which dramatically affects general condition body.

The disease is dangerous because it has a fairly high risk of developing severe consequences for the body to varying degrees, up to and including death.

Reasons

The mechanism of necrosis is the inability of pancreatic tissue to resist the destructive effect of aggressive enzyme juice. Pancreatic juice has an alkaline reaction, which, after entering the intestine, is neutralized by the acidic contents of the stomach. But in cases where enzymes cannot be removed from the gland, alkali breaks down the protein elements of the cells. The destruction spreads to the blood vessels piercing the gland and creates injuries from which blood leaks. The process of destruction of organ cells by enzyme juice is called autoaggression.

According to the international classification of diseases, pathology belongs to the subgroup “ Acute pancreatitis» with code K85.

The more pancreatic juice is produced, the faster self-digestion occurs, and the more acute its manifestations.

Hemorrhagic pancreatic necrosis can cause damage and death of cells in other organs located in close proximity to the pancreas.

Provoke the beginning pathological process The following factors can:

inflammatory foci in the gland that arise due to impaired excretion of enzyme juice;
systematic toxicity ethyl alcohol for a long time;
retention of pancreatic juice in the ducts;
infectious diseases of the biliary tract (cholecystitis, cholangitis, etc.);
blockage of the bile ducts (with cholelithiasis);
increased blood clotting in blood vessels, which accompanies malignant neoplasms, and thrombosis of blood vessels inside the organ after high doses of radiation;
autoimmune disorders (vasculitis);
complications after viruses and severe infections;
overdose of certain groups of drugs;
unbearable psychological stress;
injuries and complications after surgical interventions on the organs of the food system.

The most aggressive enzymes contained in pancreatic secretions are produced to break down protein molecules of food entering the intestines. Elastase, trypsin and chemotrypsin lead to rapid destruction of gland parenchyma cells, sometimes affecting large areas. Because of this, the pancreas becomes inflamed and increases in size, which poses a significant threat to human health.

Predisposing factors for the appearance of this formidable disease are recognized:

unhealthy diet with an abundance of fats and alcohol in the diet;
pancreatitis in acute or chronic form;
Constant consumption of trans fats.

Symptoms and signs

The intensity and variations of manifestations largely depend on the size of the lesion. The affected area can be:

limited (with a small, medium or significant focus);
widespread (affecting one structural part completely, the entire gland, or diffusely scattered within the tissue).

Also, the course of pancreatic necrosis varies according to the presence of infectious agents:

The development of the disease occurs in several stages:

At the first stage, bacterial microorganisms begin to develop and multiply inside the gland. A sharp increase in their number provokes additional poisoning with waste products, which causes toxicity and weakens the organ before autoaggression. This phase lasts on average about a week.
At the second stage, due to the breakdown of parenchyma cells, foci appear purulent process and local failures form in the organ.
On last stage inflammation affects a large area and spreads to the tissues of neighboring organs, which causes an acute reaction of all body systems.

A symptom without which this pathology almost never happens - pain. Pain sensations are localized in the left side or hypochondrium on the left side. The intensity of painful sensations is pronounced and is explained by the involvement nerve fibers into the inflammatory process. As symptoms increase, the pain may become girdling and radiate to the lumbar region of the back, shoulder girdle or sternum.

Other characteristic features:

repeated vomiting (the presence of blood and bile is noticeable in the vomit);
the tongue is covered with dense yellowish deposits;
hypohidrosis of the oral mucosa;
decreased urine volume due to general dehydration;
flatulence and diarrhea;
increased body temperature, reaching fever;
sudden changes in blood pressure;
dyspnea;
Fluctuations in glucose levels can cause disorientation, a lethargic or overly excited state, and confusion.

Some manifestations can be seen when visual inspection. Such signs of hemorrhagic pancreatic necrosis are:

abdominal bloating;
purple spots with a blue tint appear on the stomach and sides. The same spots may surround the navel or appear on the buttocks, which is a consequence of bleeding in the digestive system;
breathing becomes shallow and frequent;
due to a decrease in the lumen of blood vessels, the face turns red, but with a significant drop in glucose levels, pallor develops;
acceleration heart rate and elevated heart rate;
yellowish or grayish skin on the body.

Symptoms get worse when complications occur. With a pronounced reaction of the body to a stressful state, multiple organ failure may occur. Due to internal bleeding the volume of blood circulating throughout the body decreases. Lesions can affect the liver, cause complications in the lungs, and cause purulent formations in the tissue of the pancreas and retroperitoneal region.

After this, abscesses in the abdominal cavity and the appearance of purulent peritonitis. There is a high possibility of collapse or coma.

How is diagnosis done?

The signs characteristic of hemorrhagic pancreatic necrosis are in many ways similar to the manifestations of other inflammatory diseases of the digestive system, so just examining the patient is not enough for diagnosis.

First, the doctor collects data for anamnesis, which includes answers to the following questions:

whether the patient abuses alcohol;
whether the person was intoxicated at the time of the development of clinical signs;
whether the patient has liver or biliary tract diseases.

To clarify the primary diagnosis, the doctor issues an appointment for the following diagnostic examinations:

a blood test that determines the level of presence of enzymes in pancreatic secretions. With hemorrhagic pancreatic necrosis, enzyme activity can be exceeded 6-9 times;
urine analysis with determination of uroamylase and trypsinogen;
determination of the acidity of stomach contents;
Ultrasound of the abdominal organs to detect effusion;
examination of pancreatic secretions by probing to identify bicarbonates and active enzymes;
coproscopy, which helps to determine the percentage of unprocessed fat in feces;
radiography of the pancreas;
determination of amylase and triglycerides in exhaled air;
endoscopic cholangiopancreatography;
puncture to take a sample of necrotic tissue;
magnetic resonance imaging and CT to identify foci of necrotic formations.

Treatment

With hemorrhagic pancreatic necrosis, the patient, as a rule, ends up in a medical facility after calling an ambulance, as a result of which he is admitted to a hospital and undergoes an extensive examination.

At in serious condition patient therapy should occur in the intensive care unit with constant monitoring his condition.

Treatment folk remedies is categorically excluded due to ineffectiveness. Therapy is carried out only under conditions of round-the-clock monitoring of the person’s condition by highly qualified medical staff.

Conservative therapy

In the first 3-4 days conservative treatment carried out against the background of complete fasting. At this time nutrients are administered intravenously. In order to prevent the release of pancreatic secretions, the contents of the stomach are removed by lavage.

The room in which the patient is kept must be ventilated, with a comfortable air temperature. A person should not move to reduce the spread of toxins throughout the body.

The main strategic tasks of doctors at this stage of therapy:

Relieve pain syndrome. For pain relief, drugs such as Ketanov are used, and abdominal-lumbar blockades are performed with mixtures based on Novocaine or Promedol.
Temporarily eliminate pancreatic activity and reduce chemical activity enzyme secretion. For these purposes, drugs based on Atropine sulfate, Ftorafur, Trasylol, Gordox, etc. are used.
Relieve spasms, relax tissues and eliminate tension in the pancreatic ducts. For this purpose, antispasmodic drugs No-shpa, Dortaverine or Platyfillin are used.
Reduce the load on the gland by reducing the amount of gastric secretion and bring its acidity back to normal. This is achieved with the help of antisecretolytics Ephedrine, Atropine or Kvamatel.
Prevent the worsening of infectious inflammation and increased toxicity, eliminate the possibility of suppuration in the abdominal organs. Role antimicrobial agents antibiotics such as Ceporin, Cephalexin or Kanamycin are used.
Remove toxins as quickly as possible using glucose infusions with insulin, saline or Ringer's solution.

In a large number of cases, conservative treatment does not help stabilize the patient's condition. Then the question arises about surgical method treatment.

Operative methods

If a non-infectious course of hemorrhagic pancreatic necrosis is established, laparoscopic drainage is used. In case of significant volumes of exudate, peritoneal blood purification is carried out in parallel - intra-abdominal dialysis.

When infected, choose a different type surgery: resection of the pancreas with removal of areas affected by necrosis.

In the case of large dead areas, a more serious operation is performed - pancreatectomy, which involves complete removal of the pancreas. During this complex manipulation, neighboring structures and organs can be injured, which can have drastic consequences, so it is prescribed in extreme cases.

Another radical treatment method is sequestrectomy with resection of dead areas.

Surgery does not always permanently eliminate the problem; sometimes death continues after surgery and requires repeat surgery.

The recovery period lasts about six months, after which the patient is registered at the dispensary. A person must be re-examined every six months.

Forecast

In each specific case, the outcome of the disease can be either favorable or bad. It depends on the following factors:

spread of the pathological process;
the stage at which the person received medical care;
intensity of therapeutic measures;
patient's age;
level of the patient's recovery abilities.

The average mortality rate for hemorrhagic pancreatic necrosis is 40-70%. The most common cause of death is late presentation to the hospital. The next factor is the extent of the process: the larger the area of necrotic lesions, the higher the likelihood of mortality.

Sometimes the disease results in disability. This can happen when the disease is severe or due to complications after surgery.

The chance of survival increases if you seek help early and receive correct therapy. After recovery, a person must adhere to special diet, exclude alcohol intake and be sure to quit smoking if he was a smoker before illness.

In the video, the girl talks about her medical history and life after the operation.

Diseases of the pancreas are characterized by a rapid course and a high risk of complications. A particularly dangerous disease is hemorrhagic pancreatic necrosis. With this disease, a rapid, but most importantly, irreversible process of cell death is observed. Most often, a complication develops during acute pancreatitis or during a relapse. The danger is that even timely treatment does not guarantee that necrosis will not lead to death.

Hemorrhagic pancreatic necrosis is a condition requiring emergency care

Causes of the disease

In most cases, the disease develops in the presence of the following provoking factors:

violation of the outflow of juice;
acute intoxication with alcohols;
constant irritation of gland tissues with bile;
dysfunction of enzyme production;
infectious process in the gallbladder;
blood clotting disorder;
autoimmune pathologies;
condition after chemotherapy or radiation;
pancreas injuries;
condition after organ surgery.

Provoking factors and features of gland damage in hemorrhagic pancreatic necrosis

It is characteristic that with this disease the acini are always affected. As a result, the rate of enzyme release increases sharply, leading to an increase in pancreatic juice levels. It does not have time to be excreted by the ducts and begins to activate directly inside the gland, causing its disintegration. At the same time, the level increases, as a result of which the walls of blood vessels are destroyed and, as a result, bleeding occurs.

Before starting treatment for a pathology, it is important to find out what disorders resulted from it. Based on the existing reasons, a treatment plan is drawn up.

Endocrine cells - the islets of Langerhans - are concentrated in the tail of the pancreas and produce various hormones

Symptoms of pathology

Hemorrhagic pancreatic necrosis develops quickly. The following symptoms are characteristic:

the pain is always sharp, radiating to the back and left side;
severe dryness of the mucous membranes;
nausea and vomiting;
flatulence;
hyperthermia;
redness of the skin and the appearance of purple spots;
a sharp decrease in urine volume;
increase in pressure.

The danger is that even timely treatment does not always produce results. Almost every fifth patient collapses. 30% of patients develop a mental disorder. Especially often there is rupture of gland tissue and the entry of enzymes and necrotic cells into the abdominal cavity, which causes peritonitis with purulent contents.

Comatose state is a common outcome of hemorrhagic pancreatic necrosis

Diagnosis of the disease

Pathology has only an acute period. Thanks to the characteristic signs, it is not difficult to determine the cause of the deterioration of the condition. To confirm the diagnosis, ultrasound and CT are prescribed. Acute pancreatic necrosis is especially easily detected using laboratory tests, namely:

enzyme level assessments;
urine tests for uroamylase and trypsinogen levels;
pH analysis of juice;
probing to obtain pancreatic juice and study its composition;
coprogram with fat content assessment;
triglyceride tests.

Hemorrhagic pancreatic necrosis (ICD code 10 K86.8.1) is complete or partial tissue death.

The disease is one of the pathologies that can short terms lead to the death of the patient.

The difficulty in treatment is associated both with the speed of development of pancreatic necrosis (1 day), and with the fact that the affected organ, even after treatment, does not recover and does not produce some enzymes and hormones.

That is why one of the complications of the disease becomes diabetes mellitus Types 2 and 3.

Development mechanism

What kind of disease is this and what are the reasons for its development? With pancreatic necrosis, a fistula is formed, through which the contents of the pancreas penetrate into the abdominal cavity almost unhindered.

Dead tissue, together with hemorrhagic exudate, becomes the impetus for the development of purulent peritonitis, which in 50% of cases leads to the death of the patient.

Tissue necrosis occurs due to the inability of the pancreas to resist aggressive gastric juice. Enzymes are not removed from the affected organ and alkalis begin to break down protein compounds.

That is, the pancreas begins to digest itself. The destruction doesn't stop there. Necrosis spreads to the blood vessels penetrating the organ, injuring them and causing bleeding.

Causes of pathology

Hemorrhagic pancreatic necrosis does not develop out of nowhere.

provoke serious violation the following factors may exist:

alcohol or food poisoning;
abuse of foods that disrupt the functioning of the gastrointestinal tract (spicy, salty, fatty);
allergic reactions;
autoimmune diseases;
malignant tumors accompanied by blood clotting disorders;
blockage of the biliary tract;
infectious diseases, which include acute intestinal infections, lupus and mumps;
taking drugs and medications without a doctor’s prescription;
endocrine disorders (hypothyroidism, diabetes mellitus, complicated by diseases of the digestive tract).

Among people at risk, the following categories can be distinguished:

alcoholics and drug addicts;
elderly people with a bunch of concomitant diseases;
patients with pathologies of the pancreas, liver, gastrointestinal tract;
people who regularly abuse spicy, salty, smoked and fatty foods;
people with abdominal injuries.

Symptoms of the disease

Symptoms of hemorrhagic pancreatic necrosis are always acute. It is impossible not to notice them. On initial stage the patient begins to experience nausea, sharp pain, most often localized in the left hypochondrium.

Sometimes the pain is tingling in nature, sometimes it resembles the symptoms of a heart attack. A person can reduce painful sensations only in a sitting position, always with the knees pulled up to the stomach as much as possible.

The following symptoms are also characteristic of the pathology:

abundant and frequent vomiting, which does not bring any relief;
a strong increase in body temperature to maximum values;
changes in the skin (redness, pallor, the appearance of bruises, increased sensitivity to pain when touched lightly);
against the background of pancreatic necrosis, ascites and phlegmon of the abdominal cavity develop;
Blood sugar levels rise sharply, which is especially dangerous in diabetes and can lead to;
there is a feeling of tongue being stuffed;
the volume of urine released during urination decreases sharply;
shortness of breath appears, the pulse quickens, blood pressure becomes unstable;
disorders of the nervous system are noted (lethargy or agitation);
every fifth patient experiences a state of collapse, every third falls into a coma.

Stages of progression

There are several mandatory stages of development.

In the first stage, they begin to actively multiply in the affected gland. pathogenic microorganisms. It is at this stage that the patient begins to vomit, stool becomes unstable, and body temperature rises significantly.

At the second stage, purulent decomposition of cells begins, and a failure forms in the organ. The most dangerous stage- third. Inflammation quickly spreads to areas of healthy tissue, and the destruction of the pancreas accelerates.

Considering the speed with which one stage replaces the previous one, you should under no circumstances hesitate to call an ambulance.

After the patient is taken to a medical facility, he is thoroughly examined, the type and stage of pancreatic necrosis is determined, and urgent treatment of the pathology begins.

The disease, which can develop as a result of any predisposing factor, requires mandatory hospitalization and emergency treatment.

Classification and types

Necrosis resulting from pathology is divided into several types. This allows you to prescribe the optimal treatment regimen and promptly operate on a patient taken to the hospital.

The defeat may be:

small-focal;
medium focal;
large-focal;
subtotal;
total.

The diagnosis is made based on the size of the area of the pancreas affected by pancreatic necrosis.

In the first or second stage, the boundaries are unclear. On the third, they are clearly visible and outlined. The subtotal stage involves the death of most of the organ, the total stage - the complete death of pancreatic tissue.

In the final stages, surgery cannot be avoided. Affected tissue must be completely removed.

Pancreatic necrosis is also distinguished by the presence or absence infectious process- infected or sterile.

Making a diagnosis

During examination and subsequent examination, hemorrhagic pancreatic necrosis is differentiated from other pathologies. To do this, the doctor interviews the patient, finding out whether he abuses alcoholic drinks or fatty foods, which chronic diseases is in his medical history.

a blood test showing the doctor data on the content of pancreatic enzymes (an increase in these indicators by 6-9 times indicates hemorrhagic pancreatic necrosis);
analysis of gastric juice, which allows you to quickly and accurately determine the level of acidity;
urine test for testing for ureaplasma and trypsinogen;
probing for the determination of bicarbonates and enzymes;
analysis of exhaled air for the presence of amylase and triglycerides;
coproscopy, necessary to study residual fats in stool.

A percutaneous puncture of the area of necrosis is taken, endoscopic cholangiopancreatography and, if necessary, laparoscopy of the abdominal cavity are performed, which makes it possible to see the whole picture of damage to the pancreas and other vital organs.

Only after complex diagnostic procedures do they begin to treat the patient.

Treatment of the disease

At the first symptoms of pancreatic necrosis, the patient is hospitalized. Once the diagnosis is made, the patient is sent either to the intensive care unit or directly to the operating room. It is important to act as quickly as possible to save the pancreas and the patient’s life.

Treatment consists of:

relieving pain and spasm from the bile ducts;
stopping enzymatic activity;
decreased production of gastric juice;
preventing the addition of a secondary infection.

The patient is given medications to relieve pain, for example, novocaine blockade. Anesthesia relaxes the ducts, allowing pancreatic juice get out.

WITH increased production enzymes are treated with anti-enzyme drugs, and antibacterial therapy prevents infection of other organs and tissues. This allows you to stop the process of enzymatic and humoral functions pancreas.

Conservative therapy is carried out against the background of mandatory fasting. The necessary nutrients are administered exclusively intravenously to prevent the release of pancreatic secretions.

First, all the contents of the stomach are removed by lavage. It is important to provide the patient with peace and the most comfortable conditions possible. The room should be ventilated with a comfortable air temperature. This will help prevent the further spread of toxins released by the patient throughout the body.

If there is no improvement, there is a need for emergency surgical intervention. The type of operation depends on the course of hemorrhagic pancreatic necrosis. Laparoscopy or percutaneous drainage is relevant in cases where there is no infection.

Abdominal surgery is performed when a large amount of exudate accumulates. Peritoneal dialysis is widely used, which cleanses the blood of toxins and enzymes and thereby prevents the death of the patient from intoxication with decay products.

Life after

The postoperative period is long and difficult. The most important condition recovery is to adhere to a rest regime with minimal physical activity for the duration of everything recovery period(at least 4 months).

It is necessary to take insulin-containing medications and medications that help digest food (enzymes).

A patient who has suffered acute pancreatic necrosis is prescribed the necessary physiotherapeutic procedures and physical therapy for speedy rehabilitation.

Food restrictions are lifelong. Diet involves reducing the load on the pancreas. It is important to eat regularly and often (5-6 times a day). Food should be of neutral temperature and soft consistency.

boiled or steamed vegetables;
porridge with water;
bread (dried);
light broths;
fermented milk products with minimal fat content;
poultry meat.

There are a number of products that people who have suffered this terrible disease should forget about forever.

Taboo applies to:

canned products (fish, meat, vegetables);
alcoholic drinks even in minimal quantities;
soda;
smoked meats;
fatty meats;
any fresh baked goods;
fast food;
whole milk;
seasonings;
pickles;
vegetables, fruits and berries (fresh).

It is important to adhere to such a diet in order to prevent the development of complications associated with the inability of the pancreas to produce the necessary hormones and enzymes.

Since diabetes mellitus often becomes a complication of pancreatic necrosis, it is important to monitor, undergo regular examinations and follow all medical recommendations of an endocrinologist.

Video from a patient who suffered from the disease:

Prevention of hemorrhagic pancreatic necrosis

A person at risk of contracting this pathology should take preventive measures. To do this, you should completely stop drinking alcohol and adhere to the principles of proper nutrition.

It is imperative to promptly diagnose and treat diseases that can lead to the development of hemorrhagic pancreatic necrosis - biliary dyskinesia, ulcers duodenum and stomach, cholecystitis.

It is worth remembering that even one-time abuse of fatty foods or alcohol can lead to pancreatic necrosis and, as a consequence, to complex operation and even to death.

Be especially careful about festive table should be people with a history of diabetes mellitus of any type. Simple preventive measures do not guarantee that pancreatic necrosis will not develop, but they reduce the likelihood of experiencing the pathology to a minimum.